Coxa breva: its pathogenesis and a rationale for its management

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Hip joint biomechanics

Background:

• Symptomatic coxa breva can lead to gait abnormalities.
• Surgical management of coxa breva often involves addressing the greater trochanter.
• Two primary surgical approaches include apophyseodesis and trochanteric transfer.

Purpose of the Study:

• To compare the outcomes of apophyseodesis versus trochanteric transfer for symptomatic coxa breva.
• To establish clear indications for each surgical procedure.
• To evaluate the effectiveness of surgical interventions in averting or correcting Trendelenburg gait.

Main Methods:

• Retrospective review of 44 patients (50 hips) with symptomatic coxa breva.
• Comparison of outcomes between patients treated with apophyseodesis and those treated with trochanteric transfer.
• Analysis based on patient age and presence of Trendelenburg gait.

Main Results:

• Apophyseodesis was effective in preventing Trendelenburg gait in patients 8 years or younger.
• Distal and lateral transfer of the greater trochanter was the preferred treatment for patients 9 years or older.
• Trochanteric transfer also proved beneficial for patients already presenting with a Trendelenburg limp.

Conclusions:

• Age and the presence of Trendelenburg gait are key factors in selecting the surgical approach for coxa breva.
• Apophyseodesis is indicated for younger children to prevent gait issues.
• Trochanteric transfer is recommended for older children and those with established gait deviations.